Clinical evaluation of a new pressure ulcer risk assessment instrument, the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T)

Abstract

AimTo test the psychometric properties and clinical usability of a new Pressure Ulcer Risk Assessment Instrument including inter‐rater and test–retest reliability, convergent validity and data completeness.BackgroundMethodological and practical limitations associated with traditional Pressure Ulcer Risk Assessment Instruments, prompted a programme to work to develop a new instrument, as part of the National Institute for Health Research funded, Pressure UlceR Programme Of reSEarch (RP‐PG‐0407‐10056).DesignObservational field test.MethodFor this clinical evaluation 230 patients were purposefully sampled across four broad levels of pressure ulcer risk with representation from four secondary care and four community NHS Trusts in England. Blinded and simultaneous paired (ward/community nurse and expert nurse) PURPOSE‐T assessments were undertaken. Follow‐up retest was undertaken by the expert nurse. Field notes of PURPOSE‐T use were collected. Data were collected October 2012–January 2013.ResultsThe clinical evaluation demonstrated “very good” (kappa) inter‐rater and test–retest agreement for PURPOSE‐T assessment decision overall. The percentage agreement for “problem/no problem” was over 75% for the main risk factors. Convergent validity demonstrated moderate to high associations with other measures of similar constructs.ConclusionThe PURPOSE‐T evaluation facilitated the initial validation and clinical usability of the instrument and demonstrated that PURPOSE‐T is suitable of use in clinical practice. Further study is needed to evaluate the impact of using the instrument on care processes and outcomes.

PURPOSE T in Swedish hospital wards and nursing homes: A psychometric evaluation of a new pressure ulcer risk assessment instrument

“…To address conceptual, methodological and practical limitations, Coleman et al. (2013) in the UK developed the Pressure Ulcer Risk Primary or Secondary Evaluation Tool (PURPOSE T) using “golden standard” instrument development methods in a structured five‐phase approach: systematic review, consensus study (Coleman, Nelson, Keen, & Wilson, 2014), conceptual framework development (Coleman, Nixon, Keen, & Wilson, 2014), design and pretesting (Coleman et al., 2016) and clinical evaluation (Coleman, Smith, McGinnis, & Keen, 2018).…”

“…PURPOSE T is different from traditional PU‐RAIs as it incorporates a screening step to enable nurses to quickly screen patients who are clearly not at risk, as well as risk factors informed by systematic review evidence, expert consensus and service‐user involvement (Coleman et al., 2013; Coleman, Nixon, et al, 2014; National Pressure Ulcer Advisory Panel, 2019). Rather than numerical scoring, PURPOSE T uses colour to weight risk factors supporting decision‐making as to whether the patient is “at risk” and requires primary prevention, “has an existing pressure ulcer” and requires secondary prevention or is “not currently at risk” (Coleman et al., 2018). Coleman et al.…”

“…Coleman et al. (2018) report high reliability agreement in the three‐way decision pathway (inter‐rater 81.7% and test–retest 92.0%), simple kappa statistics of agreement for PURPOSE T overall (0.71, 0.87); moreover, when classified dichotomously as “at risk/not at risk,” there was agreement (93.4%, 95.8%). Convergent validity was reported as moderate to high, associated with other measures of traditional PU‐RAI (Coleman et al., 2018).…”

Preventing pressure injuries in the emergency department: Current evidence and practice considerations

“…International guidelines recommend that risk assessment be conducted within the first 8 hours of admission; however, as we have seen from emerging evidence of the pathogenesis of PIs, this timeframe is probably inadequate in the high‐risk, severely ill individual; therefore, we propose that an initial PI assessment be conducted within 4 hours of admission to ED. Whilst the Braden scale is widely used to determine PI risk, other scales such as the Norton scale have been modified for use in the ED, and specific shorter screening tools such as the PURPOSE T are gaining popularity because of their ease of use in some settings . Dugaret recommends that rapid assessment be carried out in the ED by focussing on age and presence of elevated CRP levels and the potential for the patient to remain in the ED for a protracted time as essential assessment elements for PI prevention.…”

“…Whilst the Braden scale is widely used to determine PI risk, other scales such as the Norton scale have been modified for use in the ED, 11 and specific shorter screening tools such as the PURPOSE T are gaining popularity because of their ease of use in some settings. 43 Dugaret 7 recommends that rapid assessment be carried out in the ED by focussing on age and presence of elevated CRP levels and the potential for the patient to remain in the ED for a protracted time as essential assessment elements for PI prevention.…”